Cash for long‐term care: Policy debates,visions, and designs on the move

Cash‐for‐care (CfC) schemes have introduced a key transformation in long‐term care policies across Europe since the 1990s. The article explores the extent to which CfC policies have changed over time and into which directions, the ways in which change (if any) has occurred and the forces underlying it. By combining the literature on institutional change with ideational approaches, the article focuses on policy theories and policy designs, on modes of change and factors pushing for change within the CfC policy, and in the long‐term care and neighbouring policy fields. In doing so, we aim to contribute to understanding institutional change and the transformation of an increasingly important sector of the welfare state.     

Ideas and Institutional Change in Social Security: Conversion,Layering, and Policy Drift*

Objectives. In recent years, social scientists such as Kathleen Thelen and Jacob Hacker have introduced new concepts to assist in the understanding of institutional change. Fostering some of these concepts, this article proceeds to augment the theoretical debate on institutional change in social science and policy research. A discussion of Social Security development in the United States advances the article's main objective: to uncover the relationship between ideational processes and policy development. Methods. Qualitative and historical analysis is offered to examine three major policy episodes: the enactment of the 1939 amendments, the first mandate of the Nixon Administration (1969–1972), and the push for Social Security privatization that emerged in the 1990s. Results. First, the analysis suggests that, through the process of institutional conversion, the 1939 amendments and the Nixon‐era reforms altered the nature of Social Security. Second, the discussion on Social Security privatization stresses the impact of layering and policy drift on public and private pensions. Conclusions. The concepts of conversion, layering, and policy drift receive further empirical support through the presented analysis. Moreover, this article suggests that, for a full understanding of institutional change, a systematic analysis of ideational processes is necessary.     

Institutional evolution and abrupt change: Reforming the administration of social assistance in Finland

Historical institutionalist studies have explained institutional change as resulting from critical junctures that interrupt long periods of stability or from endogenous, incremental evolution. Building on these theories, discursive institutionalists have focused on the roles of agency, ideas and discourse as explainers of change. Combining these approaches, this article analyses Finland’s decision in 2014 to transfer the administration of basic social assistance from municipalities to the central government. This study demonstrates that institutional change can be both abrupt and evolutionary. Due to sudden, exceptional political circumstances, the decision in question was made quickly and under pressure, circumventing possible veto players. However, it was possible only because of the incremental, endogenous change that had occurred in the way in which social assistance was administered at the municipal level. It enabled a change in political discourse, which eroded the credibility of the ideational frames that policy actors had previously utilised to reject the centralised model.     

Three Routes to Pension Reform: Politics and Institutions in Reforming Pensions in Denmark,Finland and Sweden

By analysing pension reforms in three Nordic countries – Denmark, Finland and Sweden – that apply different institutional solutions in their old‐age security programmes, this article argues that the political processes that shaped the country‐specific pension set‐ups in the 1950s and 1960s had important ramifications for subsequent reform possibilities. A high degree of inertia exists not only in the institutions themselves but also in the political reform options and the ways in which pensions were reformed. The analysis shows that the ‘new politics’ was not new in any of the three countries. Furthermore, given the differences in the three cases, the analysis questions the nature of pension reform. The Swedish reform in the late 1990s was a ‘big bang’ that eliminated the old and changed everything; the Finns built on piecemeal reforms of conversion that gradually changed the whole system; and, while the Danish story appears to be one of stability and status quo, the drift of Danish policy ultimately changed the basic characteristics of the system. Although all three countries have more or less thoroughly reformed their pensions, the reform processes have differed according to both historical legacies and institutional frameworks.     

Healthcare decommodification in decentralization context: Reviewing the ideational constructions of “classless hospital policy” initiatives in Kulon Progo Regency,Indonesia

This article illustrates the emergence of radical local welfare initiatives as a political response to the imperfect national program in decentralization context in Indonesia. In order to gain further understanding of the topic, it is worth reviewing Kulon Progo Regency's experience which recently embarked on removing class stratification at any in‐patient room in all local government‐owned hospitals through “classless hospital policy” initiatives. Using exploratory case study method, this article aims to review the ideational constructions of healthcare decommodification that is displayed on this initiative. It is concluded that the classless hospital policy reflects how social citizenship was organized through the mechanism of idea contestation which originated in the past community's behavior, combined with the vested interest of political regime for then subduing market logics under state power. This circumstance ultimately has provided the groundwork for encouraging innovative welfare outcome.     

中国的制度变迁、阶级结构转型和收入不平等：1978-2005

本文结合制度主义理论与新马克思主义的阶级分析方法,提出在中国社会分层研究中“把阶级带回来”的观点。根据户口制度、单位制度、干部身份制和私有产权等造成转型时期中国不平等的重要制度性因素,建立一个以对不同形式生产性资产的占有为基础的即新马克思主义取向的中国阶级分类方式,并在经验层面展示了其较之于其他分类法的优越性。研究认为,中国正在发生的制度转型对社会不平等秩序的重塑表现为不同形式的生产性资产,即劳动力、资本、组织、技术/权威等四种所有权作用的相对转变,从而导致阶级结构的转型和贫富差距的拉大。     

Changing Local Modes of Economic and Environmental Governance in England: A Tale of Two Areas*

Objectives. Using an urban regime theory approach, the article aims to investigate the degree to which environmental policy in England is devolved to the local level of the state and integrates with local economic governance. Methods. Intensive case study research was undertaken in two local areas of the eastern region of England having divergent economic growth trajectories. Methods included analysis of local media and documentation from local and regional organizations, and 30 primary interviews with strategic local actors. Results. The Cambridge Subregion area is experiencing pressures of economic development, creating conflict around the Green Belt and contested meanings of sustainable development. In Waveney—a declining area in search of growth—local groups have struggled to manage local economic regeneration in an environmentally sustainable manner. Both areas have witnessed new territorial‐institutional developments in relation to environmental policy making, with limited evidence of policy integration at the subregional scale. Conclusion. Despite the emphasis on local policy integration through sustainable development, the relationship between the economy and the environment in England is a focus of conflict and new territorial‐institutional developments. Urban regime theory needs to broaden its focus to include the full variety of interests in local environmental policy and the mechanisms producing new territorial scales of economic and environmental governance.     

Pension privatization in crisis: Death or rebirth of a global policy trend?

From 1981 to 2007, more than thirty countries worldwide fully or partially replaced their pre‐existing pay‐as‐you‐go pension systems with ones based on individual, private savings accounts in a process often labelled “pension privatization”. After the global financial crisis, this trend was put on hold for economic, ideational, and institutional reasons, despite a rise in critical indebtedness that has facilitated pension privatization in the past. Is the global trend towards pension privatization dead or in the process of being reborn, perhaps in a somewhat different form? Several recent trends point to rebirth as policy‐makers scale back public and private pension systems, attend to minimum pensions and “nudge” rather than mandate people to save for retirement.     

Health Care during Transition and Health Systems Reform: Evidence from the Poorest CIS Countries

The poorest seven countries of the former Soviet Union (CIS‐7) moved from a centralized system of health‐care funding and delivery to a range of institutional and financial arrangements. The different paths chosen have implied different results in terms of available resources, internal efficiency, health‐care inequality, and the corresponding incidence of public expenditures. This paper examines the level, composition and allocation of public spending on health, in light of the evolution of the health systems during the transition. The financial constraints experienced by CIS‐7 countries were reflected in the decrease of health‐care quality, the collapse of the already inefficient public health activities, and the increased incidence of out‐of‐pocket expenditures. These factors, alongside the increase in poverty, resulted in a decrease in health‐care utilization, suggesting that these countries may experience difficulties in achieving the health‐related Millennium Development Goals.     

国有企业制度变迁及改革

我国的国有企业制度是在特定的体制条件和特殊的经济背景下形成的 ,既有其存在的必然性、合理性 ;同时也存在着与市场经济的相悖性。针对国有企业制度性缺陷 ,我们进行了一系列改革 ,从放权让利、立足于调整国家与企业利益关系的适应性改革 ,到转换经营机制、着重于对企业制度中的经营制度进行改革 ,再到建立现代企业制度、力求实现国有企业制度的根本变革。国有企业改革逐步深入 ,国有企业制度变迁渐进完成。进一步改革 ,要继续突出以建立现代企业制度为中心 ,实现国有企业制度的全面创新     

Preparedness within the municipal social services in Sweden: planning for the home help service organization for elderly people in war and crisis from two organizational perspectives

A study aiming at presenting the effects of increases in work strain during war and crisis on the home help service organization within the social service sector in Stockholm was carried out in 1991. This has given rise to a discussion about achieving the goals for the organization in war and crisis. Organizations are supposed to encompass qualities that allow them to achieve operative goals even if operative conditions are changed. The principle underlying preparedness planning is the maintenance of peace-time functions in organizations during war and crisis, although such functions may be restricted. Changes influencing preparedness planning within the social service organization include ongoing organizational restructuring in terms of decentralization and increases in private enterprising within the municipal social service sector. Two factors of decisive importance to organizational appropriateness are information generation and information processing. The results from the study show deficiencies within the organization's ability to generate and process information between different organizational levels about demands put on the organization in situations of war and crisis.     

Envisioning the Third Sector's Welfare Role: Critical Discourse Analysis of ‘Post‐Devolution’ Public Policy in the UK 1998–2012

Welfare state theory has struggled to come to terms with the role of the third sector. It has often categorized welfare states in terms of the pattern of interplay between state social policies and the structure of the labour market. Moreover, it has frequently offered an exclusive focus on state policy – thereby failing to substantially recognize the role of the formally organized third sector. This study offers a corrective view. Against the backdrop of the international shift to multi‐level governance, it analyses the policy discourse of third sector involvement in welfare governance following devolution in the UK. It reveals the changing and contrasting ways in which post‐devolution territorial politics envisions the sector's role as a welfare provider. The mixed methods analysis compares policy framing and the structural narratives associated with the development of the third sector across the four constituent polities of the UK since 1998. The findings reveal how devolution has introduced a new spatial policy dynamic. Whilst there are elements of continuity between polities – such as the increasing salience of the third sector in welfare provision – policy narratives also provide evidence of the territorialization of third sector policy. From a methodological standpoint, this underlines the distinctive and complementary role discourse‐based analysis can play in understanding contemporary patterns and processes shaping welfare governance.     

Population Size,Local Autonomy,and Support for the Political System*

Objectives. Does size of democracy shape citizens' support for the democratic regime? Previous literature demonstrates that a variety of political contexts are associated with the level of system support among citizens, yet none has tested the effect of a fundamental contextual feature of contemporary societies—size of democracy—on system support from a cross‐national perspective. Methods. Survey data for nations of different sizes in Europe, North America, and Oceania are analyzed using a hierarchical generalized linear model. Results. Empirical analysis shows that less populous states and highly decentralized states demonstrate higher system support among citizens, and it offers some evidence that the negative effect of population size is moderated by the level of decentralization. Conclusions. My findings are consistent with the common expectation that smaller size of nation and governments “closer to the people” are preferred. Further, they have substantive implications for contemporary democratic governance.     

代理人困境与国家治理:兼评“风险论”

向下分权是治理幅员辽阔之国家的必然选择。在中央集权体制下,统治者采取向下分权的时候也会面临治理风险,即如果地方政府取得足够的资源和权力,它们可能对最高统治者构成威胁。曹正汉在考察中国古代统治体制演变时,提出郡县制是帝王减少代理人风险的制度安排,因为郡县制具有避免让单一地方政府强大到可以挑战帝王权威的作用。本文探讨向下分权对于集权体制政治稳定的影响。分权在为最高统治者减少代理人风险的同时,也为统治者创造了规避责难的空间。但向下分权在减少代理人风险的同时,也给统治者造成了多重代理人问题。具体而言,代理人如果没有受到有效约束,他们不但会削弱国家能力,还可能损害政权的合法性,引发社会风险。如何约束代理人始终是最高统治者面临的难题。     

Subsidiarity and social citizenship: Social assistance schemes in Austria,Belgium, Switzerland and Norway

Previous research has emphasised that conditionality impinges on social citizenship. However, a systematic assessment examining the impact of functional and territorial subsidiarity has been overlooked. Developing seven operational criteria – rights, means testing, conditionality, voice and choice, discretion, benefit's adequacy and supplementary system – we determined levels of subsidiarity and social citizenship in social assistance schemes. Analysing the benefit reform trajectories of Austria, Belgium, Norway and Switzerland, we conclude that social assistance schemes have not improved. Low benefits, means testing and work linkage have strengthened functional subsidiarity, whereas questions of voice and choice are rarely on the agenda. Caseworkers’ discretion and local administration have sustained territorial subsidiarity. Therefore, considering the potential role that benefits could play in the welfare state, low up‐take minimises the redistributive potential and, in general, risk has substantially shifted towards social assistance.     

The Impact of Caring on Informal Carers' Employment,Income and Earnings: a Longitudinal Approach

In Australia the policy balance has shifted away from institutional forms of health and aged care towards supporting people in their own homes. This change presupposes a significant and growing supply of informal caring labour. A large proportion of informal carers (40–60 per cent) currently combine paid employment with their caring responsibilities. Using the longitudinal Household, Income and Labour Dynamics in Australia Survey, the paper examines the effect of caring on employment, hours worked and earnings. The analysis shows that working age carers experience disadvantage. Carers are more likely than non‐carers to reduce their hours of work or exit from the labour force, and earn lower levels of income. In planning for an ageing population, policies will need to address these negative effects and privatised costs of caring if the supply of informal care is to be sustained in the future.     

Between Decentralized Planning and Neo-liberalism: Challenges for the Survival of the Indigenous People of Kerala, India

This paper examines the experiences of decentralization under successive political regimes in Kerala in the context of neo‐liberal policies, with reference to the impact on the lives of adivasi (indigenous) communities. The Communist Party‐led government had been implementing a home‐grown programme of decentralized planning since 1996 until it lost power to the Congress Party‐led conservative coalition in 2001. In the context of the accelerated structural adjustment and liberalization of the national government, the new government amended its predecessor's programme with a reduced role for the state bureaucratic and political actors in mobilizing people for planning and implementing projects at the local level. Based on a comparative analysis, the authors argue that the new programme has so far not been successful as regards enabling marginalized groups such as the indigenous communities to resist exclusion and move out of their states of deprivation. The study also shows that the withdrawal of the state from the social and economic sectors has adversely affected these groups.     

Reorganization of Psychiatric Services in the Sydney Metropolitan Area

An outline is given of the historical background of current attempts to modernize State psychiatric services in New South Wales. A four-phase developmental pattern in the current decentralization of facilities is described, with special reference to some traditional institutional obstacles to progress in the task of attaining an enhanced relatedness of services to community needs. It is concluded that a major deficiency in the current organization of the State-sponsored services is the lack of systematic evaluation of the effectiveness of programmes established in the past few years.     

Five years in care: documented lives and time trajectories in child welfare

Child welfare practice is temporally structured and includes a variety of follow‐up activities. Practice‐based follow‐up has not, however, been much explored when studying children's paths in the child welfare system. This paper is based on a study of children (103) who were taken into care in 2006 in 10 Finnish municipalities and their paths in care until 2011. The social workers' institutional knowledge of their ‘own’ clients comprises the core of the research design. The paper reflects on the nature of this data from the point of view of the notions of temporality. The analysis highlights four temporal trajectories used in retrospective analysis of children's paths in care: the linear time trajectory of the decisions and changes in the institutional positions, the temporally fragmentary trajectory of childhood and youth, the circular time trajectory of professional understanding of the child's path and the silent time trajectory. Each one documents the children's paths differently; the linear one tends to be the ‘natural’ and most easily available trajectory and consequently, the children's paths are documented via decisions and institutional positions. The analysis suggests that more attention should be given to the complexity of time and temporality when studying children's paths in child welfare.     

体制分割与中国城镇居民的住房差异

在混合经济形态下,“市场”与“再分配”权力之间的良性制衡的关系尚未形成,相反却在一定程度上对社会不平等的形成表现出层叠效应。对住房不平等的经验分析表明,当前（住房市场化时期）的住房不平等状况很大一部分是由房改前的住房分配过程和住房私有化改革过程导致的,社会成员越是接近体制的核心部门,其住房优势就越突出。这一经验研究发现表明,制度变革的渐进性和路径依赖使得根植于体制分割的社会不平等在尚未充分消退的同时,改革之前导致社会差异形成的体制分割因素依然在一定程度上活跃于当前的社会不平等中,且有可能会随着市场化的推进叠加于源自于市场的社会不平等,甚至经由市场的作用进一步延续并放大。